Cardiomyopathy in Pregancy: Apostolakis-Kyrus Flashcards Preview

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Flashcards in Cardiomyopathy in Pregancy: Apostolakis-Kyrus Deck (20):
1

What is GPTPAL?

G: Gravida: how many pregnancies
P: How many babies

2

TPAL?

T: Term
P: Preterm
A: Abortion
L: Living

3

What is a normal ejection fraction?

60-70%

4

What is a hysterotomy?

CSection for mother, needed for her survival

5

What is definition of peripartum cardiomyopathy?

Development of cardiac failure in the last month of pregnancy, or within 5 months of delivery

Absence of previous HF, no identifiable cause.

Left ventricular systolic dysfunction demonstrated by classic echo criteria: depressed shortening fraction or ejection franction

6

What is CM of pregnancy, in terms of diagnosis?

Diagnosis of exclusion

7

What are viral causes of peripartum cardiomyopathy?

ParvoB19
Herpes virus 6
Epstein Barr
CMV

8

What are risks for PPCM?

Chronic HTN
PreEclampsia
Obesity
Smoking
Hx of PP CM
AMA
Extremes of age
AA
multiple gestation: more work
HIV

9

What is the main risk factor for PP CM ?

Chronic HTN
Pre Eclampsia

10

What are S/Sx of PP CHF?

Dypsnea
Orthopnea
Cough
Palpitations
Chest Pain

11

What do you see on CXR of PPCM?

Enlarged heart
Perihilar opacification

12

What is EF definition of PPCM?

TEST: Less than 45%
NOT TEST: Or fraction shortening less than 30%
Or both

Right ventricular end diastolic dimension greater than 2.7cm (WIDENING!)

13

What is broad Tx of PPCM?

Diuretics: reduce preload
Hydralazine: reduce after load
Digoxin: inotorpic, more efficient
Heparin: prophylactic for stroke

14

What is the immediate mortality of PPCM?

2%

15

What is important to counsel in terms of pregnancy after birth?

Do not get pregnant for the next year!
75% of peole need more than a year to get back up to an EF of >50%

16

Which is better, idiopathic myopathy or pregnancy myopathy?

Pregancy! most people recover within a year or two

17

What is 10 year survival of PP CM? Idopathic? HIV?

PP: >90%
Idio: ~60%
HIV: ~25%

We have to diagnose correctly!

18

What is the time breaking point for PP CM long term risk in terms of morbidity and mortality?

Recover within 6 months: great
Not recovered 6 months: higher

19

What percent of women will have CM in the next pregnancy?

About 1/5

20

TEST: Definition of PPCM?

1. development within last onto or 5 months after birth
2. absence of another cause
3. absence of disease present before this one
4. echo confirms EF/depressed shorteining fraction